Electrocardiographic characteristics in the patients with a persistent left superior vena cava

  • Kanako Ito-Hagiwara
  • Yu-ki IwasakiEmail author
  • Meiso Hayashi
  • Yujin Maru
  • Yuhi Fujimoto
  • Eiichiro Oka
  • Kenta Takahashi
  • Hiroshi Hayashi
  • Teppei Yamamoto
  • Kenji Yodogawa
  • Yasushi Miyauchi
  • Wataru Shimizu
Original Article


A persistent left superior vena cava (PLSVC) is a congenital venous abnormality and is usually asymptomatic and does not cause hemodynamic disturbances. Therefore, it is difficult to identify it by routine examinations in clinical practice. This study aimed to elucidate the electrocardiographic characteristics for the prediction of a PLSVC. Twelve patients (9 males, 56.2 ± 18.3 years) who were diagnosed with a PLSVC were enrolled. The electrocardiographic parameters, including the P-wave duration, axis, and morphology of the P waves, were automatically measured and compared to 150 controls (77 males, 57.3 ± 14.6 years). There were no significant differences in the P-wave duration. Negative or positive/negative P waves in lead III predicted a PLSVC with a sensitivity of 100% and specificity of 81%. The P-wave axis in PLSVC exhibited a significant leftward deviation as compared to the controls (14.8 ± 21.1 vs. 54.0 ± 17.4°, p < 0.001). A receiver operating characteristic curve analysis of the P-wave axis for predicting a PLSVC exhibited an area under curve of 0.93 [CI 95% (0.87–0.98), p < 0.001), and identified a P-wave axis of less than 37.5° to have a 92% sensitivity and 83% specificity in predicting a PLSVC. A negative or positive/negative P-wave morphology in lead III was a useful finding for suggesting the presence of a PLSVC.


Persistent left superior vena cava P-wave morphology P-wave axis Electrocardiogram 



Atrial fibrillation


Computed tomography


Coronary sinus




Superior vena cava


Transesophageal echocardiography


Transthoracic echocardiography


Persistent left superior vena cava



We thank Mr. John Martin for his linguistic assistance.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

380_2018_1278_MOESM1_ESM.wmv (1.1 mb)
Supplementary material 1 Angiography of the PLSVC in case 11. The contraction of the PLSVC indicates the presence of atrial working muscle within the PLSVC. PLSVC indicates persistent left superior vena cava (WMV 1122 kb)
380_2018_1278_MOESM2_ESM.mp4 (3.9 mb)
Supplementary material 2 Propagation map movie of the activation pattern of the enlarged CS and PLSVC in case 12. CS indicates coronary sinus; PLSVC, persistent left superior vena cava (MP4 3949 kb)
380_2018_1278_MOESM3_ESM.mp4 (5.3 mb)
Supplementary material 3 Propagation map movie of the activation pattern of the enlarged CS and PLSVC in case 11. CS indicates coronary sinus; PLSVC, persistent left superior vena cava (MP4 5427 kb)
380_2018_1278_MOESM4_ESM.docx (14 kb)
Supplementary material 4 (DOCX 13 kb)


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Kanako Ito-Hagiwara
    • 1
  • Yu-ki Iwasaki
    • 1
    Email author
  • Meiso Hayashi
    • 1
  • Yujin Maru
    • 1
  • Yuhi Fujimoto
    • 1
  • Eiichiro Oka
    • 1
  • Kenta Takahashi
    • 1
  • Hiroshi Hayashi
    • 1
  • Teppei Yamamoto
    • 1
  • Kenji Yodogawa
    • 1
  • Yasushi Miyauchi
    • 2
  • Wataru Shimizu
    • 1
  1. 1.Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
  2. 2.Department of Cardiovascular MedicineNippon Medical School Chiba Hokusoh HospitalChibaJapan

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